American Muslim Adolescent Daughters' Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
American Muslim Adolescent Daughters’
Perception of Maternal Relationships
and the Influence on their Health
Behaviors: A Conceptual Model
Ghadir Fakhri Al-Jayyousi, PhD, MSC
Karen S. Myers-Bowman, PhD, CFLE
Farid Al-Salim, PhD, MA
Objectives: The goal of this qualitative research study was to better understand of how the mother-
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
daughter relationship shaped by different ecologies in a Muslim community in the United States
(US) influences their daughters’ health behaviors. Methods: Using a criterion sampling strategy,
11 immigrant Muslim mothers and their American Muslim adolescent daughters aged 12-18 years
Copyright (c) PNG Publications. All rights reserved.
who were born and also raised in the US were recruited (N=22) and interviewed. The interviews
were transcribed verbatim, coded, and analyzed following phenomenological research methods.
Results: Mothers in this sample explained that to share their health values with their daughters, they
needed to be close, supportive, open-minded, and good listeners to them. The results revealed that
daughters who perceived that their mothers’ values were shaped by 3 factors – religion, culture of
origin, and acculturation were more likely to follow healthy behaviors. Conclusion: The findings and the
conceptual model will help explain how these maternal factors can work together to shape American
Muslim adolescent daughters’ health behaviors.
Key words: maternal relationship; adolescence; health behavior; Islam; culture of origin; acculturation
Am J Health Behav.™ 2021;45(4):642-656
DOI: doi.org/10.5993/AJHB.45.4.4
M others play a significant role in raising
children and socializing them as active
members of society. They usually spend
more time with their children than fathers do, and
they are more likely than fathers to be involved with
daughter relationship reflects the tension between
the desire for independence and the need to stay
connected.3 Gilligan, Rogers and Tubman4 refer
to this as a fusion of closeness and identity, in that
the adolescent daughter likes to maintain a good
their children and to transmit information to them. relationship with her mother while simultaneously
Adolescents often prefer to confide in their mothers.1 establishing her individuality. During this stressful
These aspects of mothering not only are crucial to period, a mother must try to understand her daughter’s
children’s definition of self and identity formation, developmental needs so that a positive mother-
but they also influence later adult social and health daughter relationship becomes salient.5
behaviors. Relationship quality influences the health behaviors
Adolescents’ health status is influenced by their of adolescents.6 The quality of the maternal relationship is
many social relationships, including their maternal gauged by positive interactions, support, and relationship
relationship.2 Throughout adolescence, the mother- warmth. For example, Motl et al7 found that perceived
Ghadir Fakhri Al-Jayyousi, Assistant Professor of Health Education and Promotion and Internship Coordinator, Department of Public Health, College of Health
Sciences, QU Health, Qatar University, Doha, Qatar. Karen S. Myers-Bowman, Professor and Chair of Child and Family Development, San Diego State Uni-
versity, San Diego, CA, United States. Farid Al-Salim, Professor, Department of International Affairs and Middle East Studies, American University in Dubai,
Dubai, United Arab Emirates.
Correspondence Dr Ghadir; g.aljayyousi@qu.edu.qa
Am J Health Behav.™ 2021;45(4):642-656 642American Muslim Adolescent Daughters’ Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
social support from the family can encourage that Arab Muslim mothers in Canada keep their
adolescents to participate in physical activity. traditional food preparation. However, some factors
Another study found that maternal relationship led to decrease in cooking traditional meals, such as
quality and monitoring are associated with lower children’s preferences, time concerns, availability of
levels of substance abuse among adolescents.8 Arabic food, and length of stay in Canada.
Mother-daughter relationships are usually Adolescent girls’ acceptance or rejection of
multidimensional and are influenced by other maternal values as their own personal values
ecological factors that need to be addressed to depends on how they perceive these values.12 When
understand the influence of families on their adolescent girls have accurate perceptions of their
adolescents’ health behaviors. Previous literature mother’s values, then they will probably accept these
and qualitative research9,10 report that to understand values as their own. On the other hand, if they have an
maternal relationships and practices for immigrant inaccurate perception of these values, then they are
Muslim mothers in the United States (US), maternal more likely to reject their parents’ values. In addition,
health values should be addressed as a context. In previous research shows that accurate perception and
addition, Al-Jayyousi and Myers-Bowman9 report acceptance of maternal values are positively related
that US immigrant Muslim mothers’ health values to adolescents’ prosocial behaviors.13 As a result,
regarding eating behaviors, physical activity, and if an adolescent girl has an accurate perception of
smoking are shaped by other contexts including her mother’s health values, then she is more likely
religion, culture of origin, and the acculturation to accept these as her own health values, and as a
factor. In this study, immigrant Muslim mothers consequence, may engage in healthy behaviors. The
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
explained that religion greatly shaped their health converse is also true.
values. All of them reported that they consciously
neither drink alcohol nor eat pork, which they saw as
Copyright (c) PNG Publications. All rights reserved.
‘red lines’ for themselves and their families. When it Bronfenbrenner’s Ecological Approach
comes to culture of origin health values, the majority Figure 1 displays the model guiding the present
cooked Arabic traditional meals for their families, study. To understand the influence of mother-daughter
practiced what was common for women to do to stay relationships on the health behavior of adolescents,
active in their culture of origin, and followed the we should be aware of the contexts in which this
smoking customs accepted by their old culture such relationship occurs, and the interrelationships
as using argile. The mothers in this study indicated between those contexts. Bronfenbrenner’s ecological
that they were free to follow their religious values approach14 has focused on the interactions among
in the US and never felt forced to change them. the developing child, the immediate environment
However, some talked about how they left out some in which he or she lives, and the influence of the
culture of origin values over time and made some broader context in which this interaction takes
changes in the new culture. Aljaroudi et al11 reported place. These contexts, according to Bronfenbrenner,
Figure 1
A Diagram Represents Factors Influencing Maternal Relationships and their Influence on
American Muslim Adolescent Daughter’s Health Behaviorp
Religion
Mother’s Daughter’s Adolescent
Mother-Daughter
Health Values Perception Daughter Health
Relationships
Behaviour
Culture of
Origin
Acculturation
643Al-Jayyousi et al
are microsystems, mesosystems, exosystems, and for study participation included: Muslim mothers
macrosystems. who are: (1) Arab immigrants from the Middle East
The microsystem explains the health behavior (Jordan, Palestine, Lebanon, Syria, Egypt, Kuwait,
of the American Muslim adolescent daughter by and Iraq), (2) living in the US for no less than 12
addressing her relationship with her mother as the years; (3) have adolescent daughters 12-18 years old
context. Therefore, positive maternal relationships who were born and raised in the US. By following
may enhance healthy behaviors for the daughter. criterion sampling, we were able to select information-
The exosystem focuses on the impact of external rich cases of immigrant Arab Muslim mothers and
settings that have no direct effect on the daughter. their American Muslim adolescent daughters. This
In this study, examining the mother’s religious and strategy helped illuminate the research questions,
cultural values will add another context to improve and thus, examine the phenomenon in depth.
understanding of how these values shape the mother’s We posted flyers inviting participation in Islamic
practices and her relationships with her daughter, community centers and businesses in 3 US cities;
and in turn, the daughter’s health behaviors. Finally, these were sent through e-mail lists to Muslim
the macrosystem helps examine the acculturation community members. Snowball sampling followed
factor, the struggle of immigrant Muslim mothers by asking participants to share the study information
in the US, the value conflicts, and the adjustments with those they knew who fit the criteria. Eleven
they made within the new culture. This view offers immigrant Muslim mothers and their 11 Muslim-
a better understanding of the factors that shape American adolescent daughters participated. Table
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
mother-daughter relationships, and in turn, the health 1 describes the sample where M stands for Mothers
behaviors of adolescent daughters. and D for daughters, and each is given a number to
There is a paucity of literature on the quality of protect confidentiality.
Copyright (c) PNG Publications. All rights reserved.
maternal relationships in the US Muslim community After the mothers signed consent forms for
and its impact on daughters’ health behaviors. This themselves and their daughters, in-depth, face-to-
qualitative study provides pilot data to explore the face, semi-structured interviews were conducted
quality of maternal relationships between American by the first author with the mothers and daughters
Muslim daughters and their Muslim mothers and separately in an Islamic center, the public library, or
the influence on the daughters’ health behavior. in the participants’ homes. The interview questions
A conceptual model was constructed to show the with the mothers and their daughters were guided
different contexts that should be addressed and the by Bronfenbrenner’s ecological model from a
links among the different factors shaping adolescent phenomenological perspective (Supplemental Table
daughters’ health behaviors in the Muslim community. 1). The questions were originally written in English
In this study, we explored the relationship quality and then translated into Arabic. Participants were
between immigrant Muslim mothers and their given the choice to use either language. Two mothers
American Muslim adolescent daughters, and the answered the questions in English, occasionally
influence of this relationship on the health behaviors using a few Arabic expressions. All the daughters’
(eating behavior, physical activity, and smoking) of interviews were conducted in English. Each interview
the daughter. The investigation was guided by the lasted approximately 45 minutes and was digitally
following research questions: (1) What is the general audio-recorded.
nature/quality of immigrant Muslim mother-daughter The interviews were transcribed verbatim using
relationships? (2) How do maternal relationships Express Scribe software. The first author transcribed
that are shaped by religion, culture of origin, and the interviews. She listened, did the translation, then
the acculturation factor influence daughters’ health transcribed the interviews. She translated word-by-
behaviors? word to capture the meaning of the participants,
but this did not work all the time because some of
METHODS them used both languages at the same time. This
We used a phenomenological approach in this was challenging to capture, but she listened to whole
qualitative study to examine maternal relationships sentences and then translated to English and see if
regarding health behaviors of immigrant Muslim this captured the meaning the participants expressed.
mothers in the US. This approach emphasizes
capturing and describing how people directly Data Analysis
experience a phenomenon, ie, “how they perceive it, In qualitative research, the researcher is the
describe it, feel about it, judge it, remember it, make instrument of data collection and analysis. Therefore,
sense of it, and talk about it with others.”15 (p 104) during the analysis process, we explicitly identified
We used a criterion sampling strategy in the study. our biases, expectations, and reactions. Although we
The principle of this sampling method is to search and attempted to set our biases and expectations aside, we
study the cases that meet predetermined criteria that acknowledge that we described what we saw through
are important for the purpose of the study.15 Criteria our own experiences of mothering and the meanings
Am J Health Behav.™ 2021;45(4):642-656 DOI: doi.org/10.5993/AJHB.45.4.4 644American Muslim Adolescent Daughters’ Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
Table 1
Demographics for Immigrant Muslim Mothers and Age of Their American Muslim Adolescent
Daughters
Dyad Mother’s Education Job Residency Language Country of Daughter’s
Number Age in the US Used with origin Age
Mother
1 41 9th grade Part time 17 years Arabic Jordan 17
2 50 3 years in college No 27 years Arabic and Syria 17
English
3 42 Bachelor Full time 15 years English Syria 14
Degree
4 48 Diploma No 19 years Arabic Palestine 17
2 years
5 35 9th grade No 17 years Arabic Syria 16
6 43 Diploma No 19 years Arabic Syria 16
2 years
7 34 Diploma No 16 years Arabic Kuwait 14
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
2 years
8 49 2 Bachelor’s degrees Full time 28 years English Egypt 18
9 42 Master’s degree Full time 20 years Arabic and Lebanon 18
Copyright (c) PNG Publications. All rights reserved.
English
10 40 Diploma No 19 years Arabic Jordan 17
2 years
11 50 Diploma No 20 years Arabic Iraq 14
2 years
they generated in our awareness. The transcripts Middle East culture, and religious and cultural
in Arabic were translated and analyzed in English. health values were put aside. We were open to a new
Data were analyzed applying the phenomenological experience and nothing was determined in advance.
approach.
Phenomenological Reduction
Epoche Phenomenological reduction includes “describing
In phenomenological research methods, the in textural language just what one sees, not only in
epochal process is “a preparation for deriving new terms of the external object but also the internal act
knowledge but also as an experience in itself, a of consciousness, the experience as such, the rhythm
process of setting aside predilections, prejudices, and relationship between phenomenon and self.”15(p
predispositions, and allowing things, events, and 8)
So, there is return to self, which is an essential
people to enter anew into consciousness, and to requirement that cannot be ignored in phenomenology
look and see them again, as if for the first time.”16(p and in qualitative research in general. Although we
3)
In the spirit of epochs and induction, we explicitly attempted to set all biases and expectations aside, we
identified our biases, expectations and reactions to described what we saw through our own experience
make ourselves more open to others’ reality. While of mother-daughter relationships and the meanings
conducting the interviews, transcribing, and then they generated in our awareness.
during the analysis and interpretation processes we We were open and followed inductive qualitative
attempted to remain clear and open-minded. We analysis which involved discovering the themes in
were ready to learn from these mothers and their data. Data analyses began following the first interview
daughters about their experience in the US. We were and continued throughout the remainder of the data
eager to understand the challenges they were facing collection process. Developing a coding scheme is
in the new culture and the adjustments they made the first step of analysis which means analyzing the
while raising daughters who were in a critical stage core content of the interviews to determine what is
of development. Anything related to our experience important to answer the research questions.15 Several
with our mothers or daughters, the “typical” mother- readings of the data from the first interview and
daughter relationship according to Islam or the referring to the research questions were helpful in
645Al-Jayyousi et al
finding the themes and coding. This process is called behavior through different maternal practices and
bracketing in which “the focus of the research is under the influence of different ecologies. Mostakas
placed in brackets; everything else is set aside so that describes this as the “intuitive integration of the
the entire research process is rooted solely on the fundamental textural and structural descriptions into
topic.”16 (p 15) The frequent interaction with the data unified statement of the essences of the experience of
created the opportunity for new findings to emerge. the phenomenon as a whole.”16(p 18)
We analyzed the data by using constant
comparisons; pieces of data were compared for Theoretical Sampling and Theoretical Saturation
similarities and differences.17 At the beginning, each Theoretical sampling is defined as “sampling on
statement was treated as having equal value. Later, the basis of concepts derived from data”17(p 65). To
statements not related to the topic and the research employ theoretical sampling, we looked for situations
questions were deleted, leaving only the horizons, that would contribute to a deeper understanding of
“the textural meanings and invariant constituents the categories and variations within the categories, as
of the phenomenon.”(p 15) Horizons that were similar well as relationships between concepts. For example,
were grouped together into a theme and were given we recruited women from different countries from
a conceptual label later. Each theme was given a the Middle East (Palestine, Jordan, Lebanon, Egypt,
number (eg, 1.00, 2.00, etc) and we were able to Syria, Kuwait and Iraq) rather than focusing on only
develop the codebook with a list of the themes that one or 2 countries; women who have hijab and others
we found in the first interview. who do not; mothers from different educational
Next, we read the other transcripts and coded all of
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
levels, social classes and lengths of residency in the
them using the codebook. More themes were added US. For the daughters, we tried to find different ages
to the codebook as they emerged from subsequent between 12-18 years old. In addition, we gathered
Copyright (c) PNG Publications. All rights reserved.
interviews. Constant comparisons were conducted to data until we reached theoretical saturation, ie, “all
differentiate one theme from another and to identify categories are well developed in terms of properties,
dimensions of the themes.17 With each addition of dimensions, and variations,”17(p 263) a time at which
new data, themes were added and modified as needed. additional data do not provide new insights.
Finally, we organized the themes and their horizons To enhance the credibility of our research, we
under them into a coherent textural description of the applied triangulation in different stages of the study.
phenomenon. The first type of triangulation was having multiple
data sources. The first author interviewed both
Imaginative Variation mothers and their daughters; we also took notes
While reading the transcripts repeatedly, we during the interviews. Different kinds of data can
recognized the presence of some relationships among be brought together to illuminate various aspects
the themes. We started writing memos about these of the phenomenon. We also followed investigator
relationships after reading the first interview and triangulation, ie, using more than one person to do
continued until the end of the analysis process. As the the data analysis. For this study, the 3 researchers
research process progressed, the memos became more worked independently to analyze the data to help in
elaborate and integrated. These memos enabled us to the verification process. We read the transcripts and
think about the data and how concepts/themes were identified the common themes separately. Because
related to one another. Memos were used as a way to we were in different states, we used Skype and made
record developing ideas about codes, categories, and phone calls several times to compare notes on the
the conceptual model.17 Next, we were able to make themes and reach agreement.
connections among the main concepts. This enabled The second author is considered an outsider in
us to build a conceptual model that helped explain this reasearch because she is not Muslim and she is
how immigrant Muslim mothers in the US Midwest not an immigrant woman from the Middle East. She
could influence their adolescent daughters’ health is a white American mother; as a result, her analysis
behavior. This is described as “searching for the was from a different perspective than the other co-
exemplifications that vividly illustrate the invariant authors. She is not an Arabic speaker; therefore, she
structural themes and facilitate the development of a relied on the Arabic translation of one of the co-
structural description of the phenomenon.15(p 18) authors. However, we discussed the meanings of the
women’s expressions as we analyzed the transcripts.
This triangulation reduced systematic bias and
The Synthesis of Meanings and Essences distortion during data analysis. It also increased the
In the final step of analysis, we put the major credibility and quality of the findings by countering
themes with the horizons describing them and the the concern of having a single analyst who is an
theoretical model together to describe how immigrant insider.
Muslim mothers can influence their daughters’ health Finally, to enhance the credibility of the analysis
process, once themes and concepts were established,
Am J Health Behav.™ 2021;45(4):642-656 DOI: doi.org/10.5993/AJHB.45.4.4 646American Muslim Adolescent Daughters’ Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
we examined if there were any deviate (negative) they want an answer. If they ask you, they need an
cases or data that did not fit the categories. This answer and you should be honest. So, you should
added credibility by showing the “authentic search” give them the right answer. For me, I raised them
for what makes most sense rather that forcing all the to come to me and ask me and I give them the right
data toward a single finding.15 answer. I don’t want them to go ask friends, and
they understand that” (Participant 111). In addition,
RESULTS mothers in this study provided health advice to their
Major themes that arose from the analysis daughters. Participant 101 said: “She always asks for
revealed how mothers and daughters perceived my opinion regarding health, and she always accepts
their relationships. Most mothers felt they were the advice and she has no problem in this with me.”
close and supportive; however, others talked about Mothers talked about how they trusted their
mother-daughter conflict, which was shaped by daughters and gave them more freedom when they
different reasons including cultural values, the stage felt they were responsible and could make healthy
of development, and the daughter’s personality. decisions. Some mothers mentioned that it was
Additionally, the results showed how the daughter’s acceptable to them that their daughters hang out with
perception of maternal health values (shaped by friends and eat in restaurants, because they trusted
religion, culture of origin, and acculturation) would that they would make healthy choices. However,
influence the daughter’s health behavior. they also mentioned that they would be watching
their daughters, because at the end of the day it is all
the mothers’ responsibility; if the daughter acted in a
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
Perception of the Nature/Quality of Maternal way that was not accepted by the family rules, then
Relationships the mother would realize that she was not successful
All the mothers explained that their maternal in raising her daughter.
Copyright (c) PNG Publications. All rights reserved.
relationships were shaped by religion, culture of Mothers emphasized that they were supportive,
origin, and the dominant new culture. However, they flexible, and open-minded with their daughters.
showed variety in how these factors influenced their They indicated that they supported their daughters
relationships with their daughters, especially when it to stay active by competing in track, walking,
came to the new culture’s influence. Participant 108 running, and swimming. “For my daughter, I have
described: “Ah, religious values are veiled in cultural no problem for swimming, and she goes for track…
values, but it is mostly the religion that affects most of I will always support her, always. I will always say
the things that I believe in. Um, when I do let things okay for sports. Any sport for my kids, I will support
slide, that is the new culture affecting me.” them” (Participant 104). Some mothers were flexible
The mothers talked about how they tried to be regarding their daughters’ dressing for swimming,
close to their daughters, listen to them, provide them and some of them were open-minded and tried to
with advice, be flexible and supportive, give them find “Islamic swimming suits” for their daughters. “If
freedom, and trust what they would do. Participants she wears good [dresses appropriately], she could
described different types of relationships with their swim… Like there is a swimming suit that covers all
adolescent daughters. Six mothers felt that they had the body” (Participant 109). Participant 107 said:
good and positive relationships with their daughters, “So we find a solution for this, she wore a full-cover
4 mothers mentioned that their relationships were swimming suit. When she goes to swim, she will be
unstable, and only one mother mentioned that she happy.”
did not get along well with her daughter. Some mothers were also flexible regarding the
Close and supportive relationships with traditional meals they cooked for the family. If their
daughters. Mothers who felt that they had a positive daughters did not like these meals, they would try
relationship with their daughters indicated that to make some changes to be more like the new
they were close to them; they would cook healthy culture, or would even stop making that type of
traditional meals with their daughters, go to the gym meal and would try cooking American food instead.
together, and some prepared argile (water pipe) and Other participants showed that they would eat in
smoked together. Participants tried to be close to restaurants, or even eat fast food meals with their
their daughters because they felt it was the way to daughters. The mothers indicated that they did these
encourage the girls to be open with them: “I feel I things to be supportive of their daughters.
am very close to them and they feel the same. Yeah, However, the mothers also made it clear that they
especially the young daughter—too much. I mean, were not always flexible. There were times when they
she will tell me everything, I mean.” Mothers also remained firm. Participant 101 explained: “I think I
tried to be friends with their daughters, as well as have a successful relationship [with my daughter].
good listeners who tried to answer their daughters’ Thanks God. I guess I am close to her. I mean in
questions so that they did not have to search for some areas, I mean, I give my opinion and she has
other resources. “So, you have to, I mean, to be their to go with it. And at some points I am supportive in
friend. Yeah, you should try to be their friend, here what she wants to do.” They seemed to convey that
647Al-Jayyousi et al
if their daughters wanted to follow a behavior that usually argued a lot with their mothers, fighting
contradicted with their religious or cultural values, almost every day about value conflicts. However,
then they would not be supportive. Some mothers they perceived this conflict positively and said that
mentioned that they would even force their opinions this was normal. They saw it as necessary to have
and values on their daughters. healthy relationships. “We do fight a lot, almost every
All the daughters reported that they perceived day, but it is {laugh} okay. I think we are really close.
their relationship with their mothers positively. Ten of Like I, I think it is good for a healthy relationship. I
them mentioned that they felt they were close to their think it helps our relationship, because when we fight
mothers, and only one (a college student) mentioned I’ll tell her what bothers me and she will tell me what
that although they cared about each other deeply, she bothers her. It just works out well in the end. Like in
and her mother were not close enough. She said that the end I always regret it. That’s why I think it’s a
they were working on improving their relationship. good relationship with her because I don’t want to
Only 2 of the interviewed daughters described their hurt her. I will always apologize to her” (Participant
mothers as friends. “Yeah, very close, we’re like best 206).
friends. And every time like something happens in Mother-daughter conflict. Four mothers talked
my day, I will go and tell her, or somebody gave me about how their relationships with their daughters
something, you know, I will tell her. She is always were not stable; sometimes they felt they were close
excited about it, you know” (Participant 206). to their daughters, but other times they felt they were
Daughters also reported that their mothers were distant. Some mothers explained the reason for this
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
good listeners, supportive of their decisions, open- gap as being the value conflict they had with their
minded, and flexible. They mentioned that they daughters. For example, if the daughter made a
Copyright (c) PNG Publications. All rights reserved.
would go to their mothers for almost everything; in decision and the mother was not supportive because
fact, their mothers were often the first person they that decision contradicted with the mother’s religious
would talk to if they needed to know about anything or cultural values (eating Arabic traditional food,
or if they had a problem. Daughter 202 mentioned: dress modestly when playing sports, and smoking
“Yeah, usually when I have, when it is like something shisha), then the daughter would think that her mother
big or a decision about school or like something was not open-minded, or that she was old-fashioned.
important, I usually go to my mom. And most, As a result, the relationship would fall apart, and a
like, usually she has a good advice, like it is very gap would exist between them. Mothers explained
practical.” They also talked about how their mothers that their daughters wanted them to say “yes” all
supported healthy behaviors such as playing different the time, and how this would not work with them,
sports. Participant 203 said: “My mother likes me to especially if the decisions went against the mother’s
do sports, she will encourage me if I ask her. Like, [if values. “Yeah, sometimes I feel we are close. I try
I ask,] ‘Should I do soccer? Should I do basketball to be close. Supportive, ahhh, emm, well, I can’t say
this year or not?’ She is encouraging me to do them.” “yes” to everything and this is what she wants. There
On the other hand, some daughters felt that their are red lines, there are red lines in the family, and
mothers were not open-minded, and they had a if she crossed them there will be conflict. So, if we
perspective that prohibited them from going to their agree on values it will be very nice between me and
mothers for personal issues. For example, Participant her. You know the same” (Participant 106).
201 said: “Yeah, yeah. I talk to her about almost Other mothers mentioned that distant mother-
everything. I feel like she is supportive most of the daughter relationships could be caused by the stage
time, but sometimes our opinions differ, because of of development their daughters are in – adolescence.
culture-wise. Like I feel like that is a barrier. You Issues such as identity formation, independence,
know, maybe she has a different mentality toward and the social changes that occur for their daughters
something [than I do].” Other daughter participants in this stage could explain the conflict. Participant
felt that their mothers liked to give their opinions 108 explained, “Um I think we are close, but some
about everything the daughters did, and they felt that days, she is, it’s the age of [needing] independence.
their mothers wanted their values to reflect on them. That’s the part that really kind of pulls her away.”
“Well, it depends on what is this about. Like when it Participant 107 mentioned that the reason she was
is, like goes against Islam or maybe like Allah didn’t not close to her daughter is because her daughter
say something specifically about it, and she will was raised in a new and different culture. She said
be like, ‘Ask Sheikh’ or ‘Okay, ask somebody who that she was influenced by her relationship with her
is really knowledgeable.’ She will say, if it is okay, own mother, and she explained how, in her culture of
‘Go for it.’ But she obviously gave her opinion” origin, mothers were very attached to their daughters
(Participant 206). and knew everything about them, but in the new
Others mentioned that their mothers did not give culture the girls are not as attached to their mothers.
them enough space. These participants said they She explained they had “restricted feelings” toward
Am J Health Behav.™ 2021;45(4):642-656 DOI: doi.org/10.5993/AJHB.45.4.4 648American Muslim Adolescent Daughters’ Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
them, and they had secrets. activity. Participants mentioned that when they
The only mother who mentioned that her competed in track and/or swam, they would dress
relationship was not good with her daughter modestly. “I am also practicing track and I will be
explained that there were some individual factors that with boys and girls and I will wear something under
were influencing their relationship. For example, she my shorts. You know, all will be covered” (Participant
mentioned that her daughter was stubborn, and that 202). Participants who practiced swimming talked
over time her stubbornness had gotten worse. On the about how it was a challenge for them to swim and
other hand, the mother said it might be her fault that keep their religious values. “We swim in undershirts
they did not have a good relationship because she and then t-shirts. It is kind of like a lot of clothes, but
was always stressed. This was what she said when we are used to it. And then sometimes like we go and
asked about her relationship with her adolescent we sleep over in our friends’ houses or something
daughter: “You touched a sensitive nerve… You know, and they usually have neighborhood’s pools, and
I feel my daughter, ahhhh, the older she is the harder they were like closed at night. But we just like sneak
it is to deal with her. She is getting more stubborn in because nobody is there, and we just swim like
than before you know…Sometimes, I try sometimes in regular clothes like shorts and like a tank top”
to get close to her. I sometimes tried, maybe it is my (Participant 201).
mistake, I am stressed and nervous person in nature.” Regarding drug use, all the participants mentioned
Daughters’ Perception of Maternal Relation- that they had never tried alcohol and that it was a
ships (Shaped by the 3 Factors) and Influence on “red line” for them. In addition, 9 participants were
their Health Behaviors nonsmokers, partly because of their religious values.
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
Seven daughters felt that they were following “Yeah. I personally think smoking is like one of the
healthy behaviors regarding eating behavior, physical most disgusting things…I don’t do that; it is not
activity, and drug use. These participants did not eat part of my religion. It is not part of my, you know,
Copyright (c) PNG Publications. All rights reserved.
pork, tried to eat vegetables and fruits, enjoyed the how I grew up. I am not interested in it like at all”
Arabic traditional meals cooked by their mothers, (Participant 201).
which they considered healthy meals, and avoided The daughters showed positive perceptions of the
eating junk food or restaurant food. “I personally influence of Islamic values on their health behaviors.
hate like the fast food and stuff. It doesn’t appeal to Participant 206 shared: “In Islam it tells us, like,
me whatsoever. I try to keep away from that. I don’t um, well it tells us, encourages us to take care of
eat school lunches…because my mom cooks Arabi ourselves, and to exercise, eat healthy, not to smoke,
food all the time. I love Arabi foods. Even like when not drink, not eat pork. And all this is good for us,
we go out, I would rather, I prefer my mom’s food not because we should do it, but because it is good
over restaurants’ foods” (Participant 201). for us.”
The daughters tried to be active and exercise Influence of mother’s culture of origin values on
regularly; they attended gym clubs, ran, walked, adolescent daughter’s health behavior. Participants
competed in track, and/or swam. Additionally, they showed that their health behavior was also shaped
did not smoke cigarettes, and they had a negative by the values of their mothers’ culture of origin,
perception of smoking. though it seemed to be the least influencing factor.
The other 4 participants mentioned that they were They liked eating the Arabic traditional meals their
working on improving their health by trying to eat mothers cooked for the family, and thought the meals
healthy and be active. They ate fast food, did not were healthy. These meals include rice, vegetables,
exercise regularly, and 3 of them were using argile with meat or chicken. For physical activity, they
with their mothers. These healthy and unhealthy showed that they might quit the sports that were
behaviors were shaped by 3 factors – religion, not accepted by their mothers’ cultural values such
mother’s culture of origin, and the dominant new as swimming. “Sometimes, when it comes to school
culture. activities though, she is kind of like, backs off. She
Influence of mother’s religious values on will be like, ‘Oh, what do you need those for?’ Like,
adolescent daughter’s health behavior. All the for example, I did track for a year, and, I don’t know,
participants showed that their health behaviors were I could say that’s the most they provided. Like they
shaped by their mothers’ religious values. Regarding didn’t, they didn’t stop me from doing this, but they
eating behavior, all of them mentioned that they did were like, ‘Whatever, you can do it.’ Um, but yeah,
not eat pork, ham, or gelatin, and that they would then I didn’t really like that, so I kind of backed
always read the ingredients for whatever products down” (Participant 201).
they bought. Only one participant mentioned that For some daughters, their drug use values were
she also followed religious values regarding the food shaped by the old culture of their mothers. Three
portion size: “I follow no pork, no alcohol. I follow participants were using argile with their mothers.
100%. But, like, even in moderation and everything, “We will have shisha together, like most of the time,
I follow that too” (Participant 209). like it is part of the culture. It is part of the Arab
Religious values also shaped their physical culture. So, it is kind of one of those things that are
649Al-Jayyousi et al
accepted by the culture” (Participant 209). these daughters were more likely to follow healthy
Influence of US acculturation on the adolescent behaviors even when their mothers did not, because
daughter’s health behavior. Daughters also they would have the freedom to make healthy choices
showed that they were influenced by acculturation in in the US. For example, Participant 202 felt that her
the US. Some of them showed that they were eating mother’s health values were shaped by the 3 factors.
fast food and/or eating out at restaurants. This was a Although the mother herself was not active, the
habit for the family of Daughter 203 whose mother daughter followed healthy behaviors; she was eating
was a physician: “Every weekend we sort of do that. healthy most of the time (more fruits and vegetables,
Most of the time we go to have breakfast.” All the no soda, no chips, avoided eating fast food or eating at
daughters identified that their physical activity was restaurants), was very active (did track, tennis, swim,
shaped by the new culture. They loved to be active, ran, and walked), and did not smoke. Therefore, the
walk, run, play sports, go to the gym, run track, or daughter agreed with her mother on eating behaviors
swim. The majority believed that the American and drug use but was more active than her mother.
culture educated them and increased their awareness She said she was influenced by the new culture with
about healthy behaviors. “I think I am influenced by regard to the freedom to make healthy choices and
the American culture, because they care a lot about stay active, adding that her mother was also open to
physical activity and healthy foods. It is not that they these new values.
do it, but they do a lot of awareness. They will tell Three daughters (201, 203, and 206) mentioned
you what’s right and wrong” (Participant 206). that their mothers’ health values were shaped mainly
One participant (209) mentioned that she swam in by Islam and their Arab culture of origin. These
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
mixed pools and wore a swimming suit: “I mean, like participants perceived their mothers’ religious values
I was always able to wear everything else, and to be positively. Participant 206 explained how religion
in the pool and I can wear swimming suits, and I can asks Muslims to stay away from smoking and eating
Copyright (c) PNG Publications. All rights reserved.
go to mixed pools and stuff and it has never been an pork for their benefit: “Because my religion is right,
issue.” Regarding drug use, the majority mentioned it only tells us what’s best for us, like no smoking.
that the dominant new culture played a big role in Why? Because it is harmful for our bodies, and we
educating them about the negative consequences respect our body. We care about it. Not because
regarding drug use, especially smoking. they don’t want us to have fun or because they don’t
Daughters’ perceptions of mothers’ values and want us to enjoy our time. It is just because for our
health behavior. Of the 11 adolescent girls, only 5 own good. They will ask us to do things and follow
participants mentioned that their mother’s health behaviors that are good for us.”
values were shaped by the 3 factors of religion, These daughters perceived their mothers’ values
culture of origin, and acculturation to the US. Four regarding eating behavior and drug use positively,
daughters identified that their mothers’ values were but they perceived their mothers’ values regarding
mainly shaped by 2 factors, 3 of them emphasized physical activity negatively. As a result, with the
religion and culture of origin, and one participant influence of the new culture on them, they would
said that the 2 most important factors were religion try to be more active than their mothers, but then
and the American culture. Finally, 2 girls said that might have value conflicts with their mothers and
their mothers’ health values were largely shaped by quit the activity. One participant talked about how
their cultures of origin. she liked competing in track and riding bikes, but
The daughters who felt that there were 3 factors her mother was not supportive because she thought
influencing their mothers’ health values perceived that there was no need to practice these sports. The
these positively, and felt that their mothers had daughter (201) explained: “They’re, my parents,
healthy values and were encouraging them to follow gonna stick [to their ideas] for some reasons. And I
healthy behaviors. Some daughters talked about how think, ‘I love biking and stuff.’ For some reason they
their mothers’ health awareness improved in the new don’t. In their culture, Arab culture, it is not seen as
culture, and how they knew more about the negative something positive, you know. I don’t understand
consequences of following unhealthy behaviors than that you know.”
when they were back in the Middle East. “I think Two participants identified that their mother’s
it is just because she sees what happens to people, culture of origin was the main influencing factor to
you know, the obesity, and she just doesn’t want their mothers’ health values. These daughters showed
us to be like that. And she wants us to be healthy, different perceptions of the old culture’s values. One
and she knows a lot more about that now than she of them (204) perceived these values positively and
used to when she was living in the Middle East. She mentioned that her mother was engaging in healthy
comes here and she knows more now about that” behaviors, even though the mother was using argile
(Participant 210). and was not physically active. As a result, the
These daughters may have value conflicts with daughter’s health behavior was influenced mainly
their mothers, which they said are more about by her mother’s religious and cultural health values,
cultural values and not religious ones. As a result, because she was not active, and she was using argile.
Am J Health Behav.™ 2021;45(4):642-656 DOI: doi.org/10.5993/AJHB.45.4.4 650American Muslim Adolescent Daughters’ Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model
The other daughter (207) showed that she had a adolescent daughters in the Midwest was shaped by
negative perception of her mother’s health values the same factors: religion, mother’s culture of origin,
regarding eating behaviors, physical activity, and and acculturation.
smoking. She perceived her mother’s health values American Muslim adolescent daughters in this
and behaviors as unhealthy, and she was always study indicated that their health behaviors were
encouraging her to follow healthier ones, as she shaped by their mothers’ religious values – they did
explained: “She smokes to make her feel better She not eat pork, they dressed modestly for swimming
eats to make her feel better…That’s like her family. and track, and they did not drink alcohol. In addition,
Her old family, they eat a lot. They’re all overweight. the daughters recognized that they were influenced
They all smoke. So I am pretty sure she got influenced by their mothers’ cultural values – they ate the Arabic
by them as well…Over there she is probably like traditional meals their mothers cooked for the family,
always stuck with her family, so she doesn’t really they quit the sports that were not accepted by their
know. Or maybe when she was younger she didn’t mothers, and some used argile.
know that smoking will really hurt that much and The findings with regard to physical activity
will affect her health later.” align with another qualitative study conducted
Only one daughter (205) felt that her mother’s among university Muslim students to understand
health values were shaped mainly by religion and the sociocultural factors influencing their physical
the American culture. This daughter showed a activity.20 They reported that most participants were
positive perception of her mothers’ health values and influenced by their family health values, which
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
mentioned that generally she did not have conflicts were shaped by both the dominant culture and the
with her mother. As a result, the daughter engaged in immigrants’ culture of origin, and were implicitly
healthy behaviors: she attended the gym, she tried to shaped by Islam. A few participants showed that there
Copyright (c) PNG Publications. All rights reserved.
eat healthy and watched her weight, and she did not was explicit influence from Islam on their physical
smoke. activity, because the cultural influence was veiling
the religious influence. Immigrant students revealed
DISCUSSION that their culture of origin was the dominant factor in
This qualitative research study explored how shaping their family’s health values.
mother-daughter relationships within a Muslim Finally, the American Muslim adolescent
community in the US can influence the daughters’ daughters in this study showed that they were greatly
health behavior. To explore these maternal influenced by the acculturation factor. The majority
relationships in depth and understand how they agreed that the new culture increased their health
can influence the daughters’ health behavior; the awareness and encouraged them to eat healthy
mothers’ cultural and religious values were addressed foods. All the participants showed that their physical
as a context. In addition, the acculturation factor activity was shaped by the new culture; they loved to
was addressed as another context to understand the be active, walk, run, compete in sports such as track
influence of the new culture on the mothers’ health and swimming, or go to the gym. For drug use, the
values, and as a consequence, on the daughter’s majority mentioned that the dominant new culture,
health behavior. especially the schools, played a big role in educating
Immigrant Muslim mothers in this study tried them about the negative consequences of smoking.
to have a positive mother-daughter relationship;
they tried to be close, good listeners, open-minded, Conceptual Model
flexible, and supportive. These mothers felt that The model in Figure 1 illustrates that to have
having this type of relationship, would facilitate a better understanding of the factors influencing
sharing their health values with their daughters. the daughters’ health behavior within a Muslim
Schleifer18 explains that Muslim mothers are usually community in the US, it would be beneficial to
characterized by a willingness to be close to their address the maternal relationships created by
children, to share their knowledge, and to be available immigrant Muslim mothers in the community as a
to give assistance whenever needed. context. It shows that these maternal relationships
Ross-Sheriff and Husain19 mention that South can be explained in-depth by addressing the mothers’
Asian Muslim immigrants in the US live in a health values. Immigrant Muslim mothers’ health
complex culture, which is a combination of Islamic values in the US were shaped by religion as beliefs
teachings, the culture of national origin, and the and practices and culture of origin, with varying
dominant American culture. They then add that as degrees for both. Mothers showed variety in how
a consequence of this complexity, their children they were influenced by religion. Some mothers
pulled their values from Islamic teachings, their were conscious about religious health beliefs and
culture of origin, American society, their peers, and ideals, while others were not. Additionally, the
mass media. The findings from our study revealed mothers showed variety in how they were influenced
that the health behaviors of Arab-American Muslim by their culture of origin; their values ranged from
651Al-Jayyousi et al
conservative to liberal. may limit applying the findings and the model to other
However, these religious and cultural values non-Arab Muslim communities. Third, recruiting
were influenced by acculturation to the dominant the daughters only after their mothers talked to them
new culture. Therefore, the model addresses another about participating in the study may have resulted in
context and assures that we cannot understand some daughters feeling forced to participate and to
immigrant Muslim mothers’ health values in isolation give religious and socially desirable answers.
outside the influence of the dominant new culture.
Mothers in the current study showed variety in how
they were influenced by the acculturation factor. Implications for Research
Most of these mothers showed that they were more The findings address some gaps in the literature
religious in the US because they knew the “right regarding mother-daughter relationship quality within
Islam” here. Others explained that they were forced a Muslim community in the US, the health behaviors
to leave some of their original cultural values and of Muslim-American adolescent daughters, and the
accept some values from the new dominant culture influence of the different ecologies surrounding these
that did not contradict Islam to survive with their relationships and behavior: religion (Islam), culture of
daughters in the new culture. origin, and acculturation. Findings and conclusions of
The model explains that adolescent daughters will my study should be treated as hypotheses for future
be influenced by their mothers’ health values; yet it testing rather than as definitive. Quantitative research
depends on how they perceive these values shaped should be conducted to examine the different constructs
in the model with valid and reliable questions and
Delivered by Ingenta to IP: 5.10.31.211 on: Thu, 23 Dec 2021 09:48:27
by the 3 factors. Daughters who perceived their
mothers’ health values positively were more likely reaching more diverse and bigger sample.
to be influenced by these values than daughters Future research should also address the other
Copyright (c) PNG Publications. All rights reserved.
who perceived them negatively and, as a result, negative maternal relationships of immigrant Muslim
would shape their health behavior. In this study, the mothers and their influence on adolescents’ health
daughters mainly perceived their mothers’ religious behaviors. In addition, addressing the family context
and acculturated health values positively, ensuring and investigating the link between different parenting
that Islam and the new culture both shaped their approaches and adolescents’ health behaviors should
health behavior. On the other hand, the daughters be examined along with other health issues and
perceived some of their mothers’ cultural values behaviors (mental health, drinking, etc.). Finally,
negatively, and thus, the least influencing factor on fathers’ involvement in parenting adolescents, and
their health behavior was their mothers’ culture of their influence on adolescents’ health behaviors,
origin. should be explored.
Strengths and Limitations Implications for Practice
The first strength of this study results from Findings from this study can be helpful for health
addressing the 3 contexts, which enriched our educators who are working with mothers and their
findings. The second strength in this study is the adolescent daughters in Muslim communities in the
thick descriptive data acquired from interviewing US, specifically, and Muslim families in Western
both immigrant Muslim mothers and their Muslim- cultures, generally. Knowledge about these maternal
American adolescent daughters that enhanced the factors can be used to educate parents and enhance
accuracy of the findings. More analyses can be mothers’ skills so that they can help their daughters
conducted with the data for future research. engage in healthy behaviors. They can develop
However, this study has some limitations. The family-based interventions designed to foster a close
first limitation in this study could be from recruiting relationship and understanding between parents and
via the snowball sampling technique. We interviewed their children, and as a result, reduce their risky
mothers who were suggested to by other participants health behaviors.
and who, in some cases, were friends. Because of Second, our findings emphasize that mothers’
these friendship patterns, participants might have involvement should be part of any intervention
had similar religious and cultural values, which may implemented to promote the health of adolescents.
have limited the diversity among immigrant Muslim This focus on the mother-daughter dyad and on
mothers. The second limitation was interviewing only this relationship presents an important direction for
Arab Muslim immigrant mothers from the Middle programs, policy, and practice. The shift toward
East due to being unable to recruit non-Arab Muslim social determinants of health among young people
mothers. Although the purpose of this qualitative means that the major threats to their health and well-
study is the in-depth examination and understanding being are increasingly rooted in the organization
of the phenomenon (more so than the generalization and expectations of everyday life. This means that
of the findings to other Muslim communities), the search for protective factors must include an
interviewing only Arab Muslim immigrant mothers understanding of adolescents’ social relationships
Am J Health Behav.™ 2021;45(4):642-656 DOI: doi.org/10.5993/AJHB.45.4.4 652You can also read
